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Cited by 329Healthcare Quality and ManagementPrimary Care and Health OutcomesClinical practice guidelines implementation

The DOI matches its Crossref record; 80 of the 81 references it cites were found in a registry or an index.

Reviewing audit: barriers and facilitating factors for effective clinical audit

Open access
Johnston, G, Crombie, I K, Alder, E M, Davies, H T O, Millard, A·2000·Quality in Health Care
DOI 10.1136/qhc.9.1.23PMC PMC1743496
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Abstract

OBJECTIVE: To review the literature on the benefits and disadvantages of clinical and medical audit, and to assess the main facilitators and barriers to conducting the audit process. DESIGN: A comprehensive literature review was undertaken through a thorough review of Medline and CINAHL databases using the keywords of "audit", "audit of audits", and "evaluation of audits" and a handsearch of the indexes of relevant journals for key papers. RESULTS: Findings from 93 publications were reviewed. These ranged from single case studies of individual audit projects through retrospective reviews of departmental audit programmes to studies of interface projects between primary and secondary care. The studies reviewed incorporated the experiences of a wide variety of clinicians, from medical consultants to professionals allied to medicine and from those involved in unidisciplinary and multidisciplinary ventures. Perceived benefits of audit included improved communication among colleagues and other professional groups, improved patient care, increased professional satisfaction, and better administration. Some disadvantages of audit were perceived as diminished clinical ownership, fear of litigation, hierarchical and territorial suspicions, and professional isolation. The main barriers to clinical audit can be classified under five main headings. These are lack of resources, lack of expertise or advice in project design and analysis, problems between groups and group members, lack of an overall plan for audit, and organisational impediments. Key facilitating factors to audit were also identified: they included modern medical records systems, effective training, dedicated staff, protected time, structured programmes, and a shared dialogue between purchasers and providers. CONCLUSIONS: Clinical audit can be a valuable assistance to any programme which aims to improve the quality of health care and its delivery. Yet without a coherent strategy aimed at nurturing effective audits, valuable opportunities will be lost. Paying careful attention to the professional attitudes highlighted in this review may help audit to deliver on some of its promise.

Overview

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Crossref · 10.1136/qhc.9.1.23

Cites

80 of 80 references verified0 citation errors · 0 not checkable

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Citations

Cites

Research works printed but not linked: 36

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  2. Walshe K, editor. Introduction. Evaluating clinical audit; past lessons, future directions. London: The Royal Society of Medicine Press, 1995.
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  5. 1999, Br J Gen Pract, 49, 339
  6. 1998, Quality in Health Care, 7(suppl), s37
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  8. 1991, BMJ, 302, 390
  9. 1995, Eye, 9(suppl), 1
  10. 1996, Audit Trends, 4, 47
  11. 1994, Audit Trends, 2, 9
  12. 1993, Audit Trends, 1, 166
  13. 1994, Arch Path Lab Med, 118, 435
  14. 1996, BMJ, 312, 128
  15. 1992, Medical Audit News, 2, 18
  16. 1995, Nursing Standard, 9, 32
  17. 1992, J R Coll Physicians Lond, 26, 177
  18. 1996, Br J Gen Pract, 46, 735
  19. 1994, Medical Audit News, 4, 78
  20. 1996, Health Bull, 54, 252
  21. 10.1136/bmj.305.6859.961 · DOI
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  23. 1993, Ann R Coll Surg Engl, 75(suppl), 104
  24. 1996, The International Journal of Theory, Research and Practice, 2, 373
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  28. 1994, Medical Audit News, 4, 19
  29. 1992, Br J Gen Pract, 42, 333
  30. 1994, Health Service Journal, 104, 18
  31. 1992, Br J Hosp Med, 48, 182
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Metadata

Authors
Johnston, G., Crombie, I. K., Alder, E. M., Davies, H. T. O., & Millard, A.
Affiliations
  • Queen's University Belfast (GB)
  • University of Dundee (GB)
Corresponding author
Johnston, G
Venue
Quality in Health Care
Publisher
BMJ
Published
2000-03
Volume
9
Issue
1
Pages
23-36
ISSN
  • 1475-3898 (ISSN-L)
  • 0963-8172
  • 1475-3901
DOI
10.1136/qhc.9.1.23
PMC
PMC1743496
OpenAlex
W2128747629
Cited by
317
References
81
Citations by year
2026: 10 · 2025: 13 · 2024: 14 · 2023: 13 · 2022: 13 · 2021: 15 · 2020: 16 · 2019: 12 · 2018: 15 · 2017: 12 · 2016: 10 · 2015: 7 · 2014: 15 · 2013: 14 · 2012: 18
FWCI
34.19
Type
journal article
Language
en
Open access
Locations
  • BMJ Quality & Safety (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Healthcare Quality and Management
  • Health Sciences › Medicine › Family Practice › Primary Care and Health Outcomes
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
Keywords
clinical audit, enabling factors, quality of care, professional attitudes, litigation risk, primary-secondary care interface
MeSH terms
Attitude of Health Personnel, Evaluation Studies as Topic, Family Practice, United Kingdom, Hospitals, General, Interprofessional Relations, Job Satisfaction, Leadership, Medical Audit, Medical Records, Medical Staff, Hospital, Nursing Audit, Partnership Practice, Physician-Patient Relations, Physician's Role, Primary Health Care, Quality of Health Care, Retrospective Studies, Databases, Bibliographic, MEDLINE, Patient Satisfaction

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Data sources

Bibliographic data: Semantic Scholar, OpenAlex, Crossref.

Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).

Semantic Scholar’s data is described in: Kinney, R., et al. (2023). The Semantic Scholar Open Data Platform. arXiv:2301.10140.